Operative indications in penetrating renal trauma

In a review of 53 patients with penetrating renal injuries treated between 1978 and 1983 at San Francisco General Hospital, we correlated several factors with the extent of renal damage to determine whether major and minor injuries could be differentiated preoperatively, thereby avoiding unnecessary surgical exploration. Of 56 injured kidneys (three patients had bilateral injuries), 35 sustained major injuries, 17 minor, and four vascular pedicle injuries. The presence of shock, the degree of hematuria, the location of the entry site, and the type of injury did not permit reliable discrimination among these categories. Intravenous urography was most often nondiagnostic, and only the presence of extravasation or nonfunction was specific for major injury. Computed tomography provided accurate preoperative assessment in 11 cases, however, allowing nonoperative management in eight renal injuries.